Organization
NACOGDOCHES DIALYSIS CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KINAM C. MARTIN (CHIEF OPERATIONS OFFICER)
(817) 725-7900
Entity
Organization
Contact information
Practice address
3226 N UNIVERSITY DR STE 100, NACOGDOCHES, TX 75965-2684
(936) 559-0031
(936) 559-0037
Mailing address
1000 W CANNON ST, FORT WORTH, TX 76104-3029
(817) 725-7900
(682) 207-1030
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110360
FACILITY LICENSE
TX
05
—
366218101
—
TX
Enumeration date
09/15/2009
Last updated
07/21/2022
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